Internal Medicine

P1: SBT

0521779407-05 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:49

206 Autonomic Dysfunction Autosomal Dominant PRD

➣Florinef; increase daily dose every 2 weeks; may need 1 mg/day;

watch for recumbent hypertension, ankle edema, worsened dia-

betes

➣Prostaglandin synthase inhibitors

➣Midodrine

Ephedrine

■Other symptoms

➣Air-conditioning to avoid hyperthermia

specific therapy

■Treat underlying cause

follow-up

■As needed

complications and prognosis

■Treatment may be required indefinitely unless underlying disorder

recovers

Autosomal Dominant Polycystic Renal Disease..............

WILLIAM M. BENNETT, MD

history & physical

■family history of PKD in a parent or sibling

■if parent not tested, query early death from stroke, history of hyper-

tension or renal failure

■associated findings: hypertension, mitral valve prolapse, hep-

atomegaly (liver cysts), inguinal or umbilical hernias, colonic diver-

ticula

■ask specifically about hematuria, proteinuria, symptoms of urinary

tract infection, passage of stones or previous blood pressure eleva-

tion

■kidneys may be palpable, enlarged and tender but this is unusual in

early disease

tests

■urinalysis

■serum electrolytes

■uric acid

■BUN

■creatinine